UTAH DEPARTMENT OF WORKFORCE SERVICES



|DWS-OSD 59 |State of Utah | |

|Rev. 02/2009 |Department of Workforce Services | |

| |JOB ORDER FORM | |

|4 Ways to Submit a JOB ORDER |

|Online: jobs. |FAX: 1-866-968-0060 |

|E-mail: postajob@ |Phone: 1-888-920-WORK (9675) |

|( EMPLOYER INFORMATION |

|COMPANY NAME:       CONTACT PERSON:       |

|STREET ADDRESS:       |

|CITY:       STATE:       ZIP CODE:       |

|PHONE NUMBER: (     )     -           |

|FAX NUMBER: (     )     -           FEDERAL ID# (FEIN):            |

|EMAIL ADDRESS:            UT EMPLOYER TAX ID# (UI ID):            |

|FEDERAL CONTRACTOR (FCJL): Yes No AFFIRMATIVE ACTION EMPLOYER: Yes No |

|JOB SITE LOCATION:       |

|( JOB TITLE:                 NUMBER OF OPENINGS:       |

|JOB DESCRIPTION (Include tasks, duties, responsibilities):       |

|      |

|      |

|      |

|JOB DETAILS: |

|SALARY: From $       To $       (Hourly/Monthly/Yearly) BENEFITS: Yes No |

|HOURS: From       (am/pm) To       (am/pm) |

|SHIFTS (check all that apply): Day Swing Graveyard Rotating |

|WORK: Full-Time Part-Time Seasonal Temporary |

|DAYS OFF: Sat Sun Mon Tues Wed Thurs Fri |

|( JOB REQUIREMENTS (Must be bona fide qualifications required to perform the job.) |

|EXPERIENCE (Years/Months):       AGE:       to       |

|IS VEHICLE REQUIRED? Yes No LIFTING (lbs.):       |

|DRIVER’S LICENSE: Yes No LICENSE TYPE: A / B / C / D ENDORSEMENTS: H / N / T / X / P |

|EDUCATION: None GED HS AA BA/BS MA/MS PhD Cert./Lic. |

|COMPUTER SKILLS/KNOWLEDGE:       |

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|SPECIAL MACHINERY/TOOLS/KNOWLEDGE:       |

| |

|ADDITIONAL INFORMATION / CLOSING DATE (If applicable):       |

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|REFERRAL INSTRUCTIONS (How would you like applicants to apply?):       |

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|Would you like information about Tax Credits for hiring special populations? Yes No |

Equal Opportunity Employer Program

Auxiliary aids and services are available upon request to individuals with disabilities by calling (801) 526-9240. Individuals with speech and/or hearing impairments may call Relay Utah by dialing 711. Spanish Relay Utah: 1-888-346-3162

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